社区中老年人群QTc间期与糖尿病发生风险的相关性研究  

Association of heart rate-corrected QT interval with risk of diabetes in middle aged and elderly community-based population

作　　者：邓婵娟 朱雯 代华杰 禤立平 王天歌[1] 陈宇红[1] 张寅飞 王卫庆[1] 毕宇芳[1] 徐敏[1] 张迪[1] DENG Chanjuan;ZHU Wen;DAI Huajie;XUAN Liping;WANG Tiange;CHEN Yuhong;ZHANG Yinfei;WANG Weiqing;BI Yufang;XU Min;ZHANG Di(Department of Endocrine and Metabolic Diseases,National Clinical Research Center for Metabolic Diseases,Shanghai Institute of Endocrine and Metabolic Diseases,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Endocrine,Jiading District Central Hospital,Shanghai University of Medicine&Health Sciences,Shanghai 201800,China)

机构地区：[1]上海交通大学医学院附属瑞金医院内分泌代谢病科,国家代谢性疾病临床医学研究中心,上海市内分泌代谢病研究所,上海200025 [2]上海健康医学院附属嘉定区中心医院内分泌科,上海201800

出　　处：《内科理论与实践》2019年第6期349-354,共6页Journal of Internal Medicine Concepts & Practice

基　　金：上海市科委中央引导地方科技发展专项资金(项目编号:YDZX20173100004881);上海市申康医院发展中心临床科技创新项目(项目编号:SHDC12016202)。

摘　　要：目的:研究社区中老年人群QTc间期与糖尿病发生风险的相关性。方法:选取上海市嘉定区4942名40岁以上基线无糖尿病的居民作为研究对象,平均随访时间4.3年,对其进行标准化问卷调查、体格检查和生化检测。采用静息心电图仪测量QT间期,Bazett公式计算QTc间期。根据WHO 1999年的诊断标准,新发糖尿病的诊断需满足以下标准:空腹血糖≥7.0 mmol/L,或餐后血糖≥11.1 mmol/L,或随访期间医师诊断的糖尿病。运用Logistic回归模型分析基线QTc间期与糖尿病发生风险之间的相关性。结果:在4942名受试者中,基线QTc间期延长者共668名(13.5%),随访期间617例(12.5%)受试者发生糖尿病。校正基线年龄、性别、体质量指数(body mass index,BMI)、吸烟、饮酒、体力活动、糖尿病家族史、高血压病史、总胆固醇(total cholesterol,TC)和三酰甘油(triacylglycerol,TG)等混杂因素后,QTc间期每增加一个标准差,糖尿病发病风险增加14%[优势比(odd ratio,OR)=1.14,95%可信区间(confidence interval,CI):1.05~1.24,P=0.003];与QTc间期正常者相比,QTc间期延长者糖尿病发生风险增加了27%[OR(95%CI):1.27(1.01~1.62),P=0.04]。结论:在中老年人中,QTc间期延长是糖尿病发生的危险因素,识别QTc间期延长有助于糖尿病的早期预防。Objective To investigate the association between the heart rate-corrected QT interval(QTc interval)and incidence of diabetes in the middle aged and elderly people.Methods A total of 4942 non-diabetes residents aged 40 years and above from Jiading district,Shanghai,were enrolled in the study and followed up for average 4.3 years.Standard questionnaire,anthropometric measurements and biochemical evaluation were conducted.QT interval was measured by resting electrocardiograph and QTc interval was calculated by Bazzet’s formula at baseline.According to the WHO diagnostic criteria of 1999,diabetes was defined as fasting plasma glucose(FPG)≥7.0 mmol/L,or oral glucose tolerance test(OGTT)-2 h plasma glucose≥11.1 mmol/L,or self-reported physician-diagnosed diabetes.Logistic regression model was used to analyze the association between QTc interval and incidence of diabetes.Results Among the 4942 subjects,668(13.5%)had prolonged QTc interval at baseline and 617(12.5%)developed diabetes at follow-up.After adjusting for age,gender,body mass index,smoking,drinking,physical activity,family history of diabetes,history of hypertension,total cholesterol,triglyceride,and other confounding factors,the risk of diabetes increased by 14%for each 1-standard deviation increase in QTc interval[odds ratio(OR)=1.14,95%confidence interval(CI):1.05-1.24,P=0.003];compared with those with normal QTc interval,the risk of diabetes in those with prolonged QTc interval increased by 27%[OR(95%CI):1.27(1.01-1.62),P=0.04].Conclusions Prolonged QTc interval is a risk factor for diabetes in the middle-aged and elderly people.It is helpful to recognize the prolongation of QTc interval for the early prevention of diabetes.

关 键 词：QTC间期 糖尿病 心电图 

分 类 号：R587.1[医药卫生—内分泌]